Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec

By J. Pépin, Louis Valiquette, Benoît Cossette. Canadian Medical Association Journal, 2005

668 citations recorded by the source corpus.

Background: Since 2002 an epidemic of Clostridium difficile–associated disease (CDAD) caused by a hypervirulent toxinotype III ribotype 027 strain has spread to many hospitals in Quebec. The strain has also been found in the United States, the United Kingdom and the Netherlands. The effects of this epidemic on mortality and duration of hospital stay remain unknown. We measured these effects among patients admitted to a hospital in Quebec during 2003 and 2004. Methods: We compared mortality and total length of hospital stay among inpatients in whom nosocomial CDAD developed and among control subjects without CDAD matched for sex, age, Charlson Comorbidity Index score and length of hospital stay up to the diagnosis of CDAD in the corresponding case. Results: Thirty days after diagnosis 23.0% (37/161) of the patients with CDAD had died, compared with 7.0% (46/656) of the matched control subjects (p < 0.001). Twelve months after diagnosis, mortality was 37.3% (60/161) among patients with CDAD and 20.6% (135/656) among the control subjects (p < 0.001), for a cumulative attributable mortality of 16.7% (95% confidence interval 8.6%–25.2%). Each case of nosocomial CDAD led, on average, to 10.7 additional days in hospital. Interpretation: This study documented a high attributable mortality among elderly patients with CDAD mostly caused by a hypervirulent strain, which represents a dramatic change in the severity of this infection.

Subfields: Critical Care and Intensive Care Medicine, Infectious Diseases

View Paper: https://www.semanticscholar.org/paper/d7c8340b6fa3637765942efc303c3eb80780786a

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In Critical Care and Intensive Care Medicine

1. Victoria J. Fraser
2. J. Bartlett

In Infectious Diseases

1. J. Bartlett
2. J. H. Morse

Citations in the corpus

• Development and Validation of a Clostridium difficile Infection Risk Prediction Model (2011, background): “Despite the breadth and depth of knowledge about risk factors available in the medical literature, healthcare facilities still struggle with outbreaks of CDI and increasing rates of disease.(4-7,9,18-20) Most CDI prevention and control strategies, such as the use of contact precautions and environme”
• Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. (2008, background): “For amplification of tcdC, a forward primer that was designed inhouse was used: 5 TTTTCATATGTTTTCTAAAAAAAATGA- GGG 3 (TcdC1s).”
• The Changing Epidemiology of Clostridium difficile Infections (2010, background): “A retrospective study of all cases of CDI over a 13-year period in Quebec, Canada, reported an increase in incidence from 35.6 cases per 100,000 population in 1991 to 156.3 cases per 100,000 population in 2003 (152).”
• Narrative Review: The New Epidemic of Clostridium difficileAssociated Enteric Disease (2006, background): “The final factor is resistance in vitro to fluoroquinolones, which is infrequently observed in strains collected before 2001 and may be an important factor in the increased frequency of disease rather than contributing to its virulence (20, 66, 68, 77).”